Total intravenous anaesthesia using propofol infusion--50 consecutive cases

Fifty consecutive patients in the authors' practice were anaesthetised with a total intravenous technique using propofol infusion, fentanyl, vecuronium and oxygen in air. Patients were predominantly elderly and undergoing major upper gastrointestinal surgery for a mean duration of 133 minutes (range 20 minutes to 7 hours). Twenty-one patients had significant concomitant medical illness. Propofol was found to give a rapid, smooth induction with wide variation in dose requirement (0.5 to 2.9 mg/kg). There was a mean systolic blood pressure fall of 27% from preoperative values, greatest in elderly patients. Depth of anaesthesia was readily adjusted by alteration in infusion rate according to standard clinical criteria. The dose of propofol required for maintenance was highly variable (range 2-15 mg/kg/hr in the first hour). Three patients reported dreaming and two of these had shown signs of light anaesthesia. Recovery was rapid, with few side-effects, and a mean time to open eyes on command of 8.5 minutes from the end of infusion. Propofol was considered to be a satisfactory intravenous agent for the induction and maintenance of anaesthesia in the majority of patients studied. The most significant problem was hypotension following the induction dose.